200 River Place, Suite 150, Monona, WI 53716

Application is available online 24 hours a day, 7 days a week. Hours are based on the availability of the volunteer cosmetic dentist.

- Visit the website for more information or to complete the application. Only applications submitted online will be considered. - When an application is received, applicant will be sent a letter letting them know if they initially qualify or not. - If eligibility criteria are initially met, GBAS will contact a participating dentist closest to the applicant’s area to ask if he/she will accept the case. If accepted, GBAS will contact the applicant with the referral. The applicant must then schedule an appointment within 30 days with the participating volunteer dentist. This is a volunteer program and the dentist decides what kind of dental work fits within the program's guidelines. Applicants are not accepted into the program until the dentist sees the applicant for a consultation.

$20 nonrefundable application fee.

Program applicants must meet all criteria: - Must be an adult survivor who received dental injuries from a former intimate partner or spouse, due to sexual assault, or due to human trafficking. - Must be a survivor whose injuries are to the smile-zone (the front eight (8) teeth). The program does not replace work that has been already repaired through previous enrollment in the GBAS program or by the survivor's own dentist. Does not help with dental neglect (such as cavities), gum disease, jaw injuries, or orthodontic treatment. - Must have reliable transportation or ability to obtain transportation for up to 200 miles from home. - If hurt by an intimate partner or spouse: Must be out of all abusive relationships for at least one (1) year, unless the abuser has died or is in jail/prison.  - If hurt because of sexual assault or human trafficking: It must have happened at least one (1) year ago. - Must have at least one (1) interview to connect them with local resources, to confirm that the injuries were caused by domestic violence or sexual, and that the applicant has been out of an abusive relationship or situation for at least one (1) year. Contact information for the domestic violence/sexual assault advocate, case manager, counselor, faith leader, therapist, or doctor with experience in counseling survivors of domestic violence/sexual assault must be provided on the application for acceptance into the program.

None.

United States